<?php
include($includes_path.'/functions.inc.php');
?>

<div class="widgetBox">
    <h3>We want to know all about you.. well at least the following:</h3>
    <form class="softForm" method="POST" action="">
        <fieldset>
            <legend></legend>
            <label for="user">Full name</label>
            <input type="text" name="sname" value="<?php print($_POST['sname']); ?>" />
            <input type="text" name="name" value="<?php print($_POST['name']); ?>" />
            <br />
            <label for="name">Company</label>
            <input type="text" name="company" value="<?php print($_POST['company']); ?>" />
            <br />
            <label for="mail">E-mail:</label>
            <input type="text" class="idleField" name="mail" value="<?php print($_POST['mail']); ?>" />
            <br />
            <label for="topic">Topic:</label>
            <select name="topic">
                <option>Question</option>
                <option>Job offer</option>
                <option>Webdesign</option>
                <option>Tip</option>
                <option>Other</option>
            </select>
            <br />
            <br />
            <label for="message">Your message:</label>
            <textarea class="cms_txtarea" name="msg" cols="0" rows="0"><?php print($_POST['mail']); ?></textarea>
            <br />
        </fieldset>
        <fieldset>
            <legend></legend>
            <input type="submit" value="Submit information"  />
            <input type="reset" value="Reset form" name="reset" />
        </fieldset>
    </form>
</div>